ATTITUDES OF SWEDISH GENERAL PRACTITIONERS AND NURSES TO WORKING WITH LIFESTYLE CHANGE, WITH SPECIAL REFERENCE TO ALCOHOL CONSUMPTION
Abstract
AIMS: To explore the attitudes of Swedish general practitioners (GPs) and nurses to secondary alcohol prevention (early identification of, and intervention for, alcohol-related problems) and compare it to their attitudes to other important lifestyle behaviours such as smoking, stress, exercise, and overweight. METHODS: An adjusted version of The WHO Collaborative Study Questionnaire for General Practitioners was posted to all GPs and nurses in the County of Skaraborg, Sweden; 68 GPs and 193 nurses responded. RESULTS: The importance of drinking alcohol moderately, counselling skills on reducing alcohol consumption and perceived current effectiveness in helping patients change lifestyle behaviours ranked lower than working with all the other lifestyle behaviours. The nurses rated their potential effectiveness in helping patients change lifestyle higher than that of GPs for all the lifestyle behaviours. Nurses receiving more alcohol-related education had more positive attitudes than nurses with less education. For alcohol, the GPs assessed their role adequacy, role legitimacy and motivation higher than that of the nurses. The main obstacles for the GPs to carry out alcohol intervention were lack of training in counselling for reducing alcohol consumption, time constraints, and the fact that the doctors did not know how to identify problem drinkers who have no obvious symptoms of excess consumption. CONCLUSION: GPs and the nurses estimated their alcohol-related competence as lower than working with many other health-related lifestyles. These results can be explained by lack of practical skills, lack of training in suitable intervention techniques, and unsupportive working environments. All these elements must be considered when planning secondary alcohol prevention programs in primary health care.
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Few at-risk drinkers are identified as such and counselled to cut down.
“However, few at-risk drinkers are identified as such and counselled to cut down [17–23].”
In 9 survey studies, the majority of GPs and nurses who received training reported that those programmes lasted less than four hours.
“In 9 survey studies, the majority of the GPs and nurses who received training reported that those programmes lasted less than four hours [20, 23, 44, 46, 47, 70, 76, 78, 79].”
In 1 survey study from Sweden, nurses scored neutral on a motivational scale from 1 to 7.
“In 1 survey study from Sweden, nurses scored neutral on a motivational scale from 1 to 7 [20].”
Having these resources and displaying information in the waiting room were reported as facilitators in several studies.
“Having these resources and displaying information in the waiting room (e.g. posters) were reported as facilitators in several studies [20, 23, 37, 39, 47, 55, 78, 92].”
The majority of GPs in 9 studies and of nurses in 3 quantitative studies felt they were not skilled enough to deliver alcohol SBI.
“On the one hand, the majority of the GPs in 9 [20, 44, 47, 57, 59, 62, 67, 83, 104], and of the nurses in 3 quantitative studies [20, 59, 84] felt they were not skilled enough to deliver alcohol SBI;”
The majority of GPs in 14 studies and of nurses in 2 quantitative studies reported the opposite, that they felt skilled enough to deliver alcohol SBI.
“on the other hand, the majority of the GPs in 14 [16, 20, 23, 36, 52, 62, 64, 70, 78, 83, 95, 106, 108, 111], and of the nurses in 2 quantitative studies [36, 70] reported the opposite.”
Of 23 studies, 16 found that a majority of GPs believed they were confident in their abilities to screen and advise at-risk drinkers.
“Twenty-three studies reported on how GPs felt about their abilities for screening and advising at-risk drinkers, of which 16 found a majority of GPs believed they were confident in their abilities [20, 36, 40, 44–47, 50, 52, 59–62, 64, 65, 67, 78, 81, 83, 104, 106, 108, 111] compared with 1 of 3 studies involving nurses [20, 36, 59].”
In 1 of 3 studies involving nurses, a majority of nurses believed they were confident in their abilities.
“Twenty-three studies reported on how GPs felt about their abilities for screening and advising at-risk drinkers, of which 16 found a majority of GPs believed they were confident in their abilities [20, 36, 40, 44–47, 50, 52, 59–62, 64, 65, 67, 78, 81, 83, 104, 106, 108, 111] compared with 1 of 3 studies involving nurses [20, 36, 59].”
GPs and nurses reported more training for improving counselling skills and feedback on successful cases as facilitators.
“GPs and nurses reported more training for improving counselling skills [20, 49, 78, 83] and feedback on successful cases [71] as facilitators.”
The majority of GPs in 7 of 11 studies, and of nurses in 2 studies, did not feel their advice would have much impact.
“Notwithstanding, the majority of the GPs in 7 from a total of 11 studies [20, 53, 55, 59–62, 65, 78, 83, 108], and of the nurses in 2 studies [20, 85], did not feel their advice would have much impact.”
In 4 quantitative and 4 qualitative studies, GPs were sceptical that patients would follow their advice.
“In 4 quantitative and 4 qualitative studies GPs were sceptical that patients would follow their advice [20, 42, 47, 49, 78, 83, 91, 107];”
In 5 survey studies among GPs, 4 found that a majority of GPs did not believe patients would resent being asked about alcohol.
“This issue was addressed in 5 survey studies among GPs, of which 4 found a majority of GPs did not believe patients would resent being asked [20, 23, 47, 56, 78].”
With the exception of 1 study on GPs from Sri Lanka, the majority of GPs in the remaining 13 studies and of nurses in 3 studies reported feeling unsatisfied advising patients to cut down.
“With the notable exception of 1 study on GPs from Sri Lanka [67], the majority of the GPs in the remaining 13 studies addressing this issue (8 from the UK), and of the nurses in 3 studies (2 from Sweden and 1 from the UK) reported feeling unsatisfied advising patients to cut down [16, 20, 23, 44, 57, 59–62, 73, 78, 94, 108].”
Better co-operation with specialized services, involving other professionals in general practice, public health educational campaigns, and more media attention were among the most commonly cited facilitators.
“Better co-operation with specialized services [20, 39, 59, 60, 80], involving other professionals in general practice (e.g. an addiction consultant or a specialized nurse) [39, 71, 105], public health educational campaigns [23, 47, 78, 99, 110] and more media attention [39, 110] were among the most commonly cited facilitators.”
Only 24% of GPs and nurses in 2 survey studies from the Nordic countries agreed with financial reimbursement as an incentive.
“however, only 24% of the GPs and nurses in 2 survey studies from the Nordic countries agreed with this [20, 36].”
Lack of resources included lack of screening tools, counselling materials, and specific guidelines.
“Lack of resources included lack of screening tools [20, 23, 47, 74, 78], counselling materials [20, 23, 42, 47, 78, 109] and specific guidelines [103].”
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- Authors
- GEIRSSON, M., BENDTSEN, P., & SPAK, F.
- Corresponding author
- GEIRSSON, MAGNUS
- ORCID
- BENDTSEN, PREBEN
- Venue
- Alcohol and Alcoholism
- Publisher
- Oxford University Press (OUP)
- Published
- 2005-07-25
- Volume
- 40
- Issue
- 5
- Pages
- 388-393
- ISSN
- 0735-0414 (ISSN-L)
- 1464-3502
- OpenAlex
- W2081364910
- Cited by
- 93
- References
- 36
- Citations by year
- 2025: 4 · 2024: 5 · 2023: 4 · 2022: 1 · 2021: 10 · 2020: 3 · 2018: 4 · 2017: 3 · 2016: 8 · 2015: 11 · 2014: 2 · 2013: 6 · 2012: 5
- FWCI
- 1.91
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Alcohol and Alcoholism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Keywords
- alcohol consumption, lifestyle modification, general practitioners, nurses, professional attitudes, role legitimacy, primary care, smoking, stress, physical activity, overweight
- MeSH terms
- Adult, Alcoholism, Attitude of Health Personnel, Education, Medical, Graduate, Female, Humans, Health Knowledge, Attitudes, Practice, Life Style, Male, Middle Aged, Nurses, Patient Compliance, Physicians, Family, Sweden, Health Behavior, Secondary Prevention
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